RHEUMATOID ARTHRITIS (RA): PROTECTING ANKLES AND FEET

March 22, 2011

RA in the feet can cause swelling and stretched ligaments, and over time the foot often becomes broader and the toes higher than they were before. One of the best ways to protect your feet and ankles is to wear the proper footwear because a shoe that fits poorly can injure sensitive toes and feet and cause further deformity.
Do not under any circumstances purchase a shoe that rubs or causes pressure and then expect to break it in. This will only come to pass at the expense of your feet. The best advice really is, “If the shoe fits, wear it.” When shopping for shoes, look for the following features:
•      light weight
•      deep enough to clear top of toes; deeper if insert is needed
•      wide enough not to pinch toes together
•      breathable, supple uppers (leather or canvas); seamless deerskin or calfskin are the best materials
•      one inch or smaller heel
•       good shock absorption when heel contacts ground; crepe soles are excellent for this
•      good support along the inside of the foot
•      durable, stiff back for support.
People with RA often have difficulty finding shoes that are comfortable, practical, and stylish. If the arthritis in your feet is mild, shoes that are deep and wide, such as good supportive walking shoes or athletic shoes, will usually suffice.
If you have minor deformities of the feet, you may require an insert, or orthosis, for your shoes. These foot supports can be purchased over the counter, or they can be specially designed for your feet by a podiatrist, orthotist, or pedorthist. Supports are designed to relieve pressure on sensitive areas by distributing the pressure to other areas of the foot. Some orthoses can actually prevent or even correct deformity. You will need to purchase shoes that are wide and deep enough to accommodate the orthosis. Many shoe stores sell special shoes for this purpose. Call ahead and ask if the store carries extra wide, extra deep shoes.
Sometimes an extra piece of rubber or leather (metatarsal bar) is applied externally to the sole. This takes pressure off the ball of the foot, frequently an area of discomfort.
If you have severe foot damage or deformity you may require specially made shoes. Orthopedic shoes or custom-made shoes can be fabricated from a cast of your feet. Some newer versions are more stylish than the classic orthopedic shoe. Your doctor, therapist, orthopedic surgeon, or podiatrist may be able to give you the name of the best manufacturer of orthopedic shoes in your area. These shoes are generally quite expensive so ask around before you invest your money. It is important that you select a provider who is willing to make adjustments if the first pair feels uncomfortable to you. Also, find out whether a second pair can be purchased at a reduced fee.
Splints are occasionally recommended for the back of the foot and the ankle. Your physician will tell you whether a foot splint might be useful for you.
Finally, here is some excellent advice from Dr. John Ward and Dr. Carolee Moncur of the University of Utah Medical Center about foot care for people with arthritis:
•      Keep your feet meticulously clean and dry, particularly between your toes.
•      Examine your feet often for signs of stress.
•      Look for blisters and pressure sores. Change your shoes or get professional advice if these signs of stress develop.
•      Avoid chemical agents or cutting to remove calluses; they have formed for a reason. Find out what that reason is.
•      Cut your toenails straight across.
•      Plan ahead to avoid excessive walking when your feet are painful.
•       Keep your weight low.
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RHEUMATOID ARTHRITIS: HINTS TO PROTECT ELBOWS, SHOULDERS, HIPS AND KNEES

January 17, 2011

Elbows and shoulders
Here, as with hands and wrists, the principle is to avoid putting stress on the joint in a way that contributes to deformity. For example, when you are carrying heavy objects, keep them as close to your body as possible so that your spine can relieve some of the stress on your shoulders, elbows, and wrists.
Assistive equipment. Assistive equipment to relieve stress on shoulders and elbows includes items that have extended handles and items that allow you to carry things without using your arms.
•       extended handles on combs, hairbrushes, toothbrushes, utensils
•      extended handle dustpan
•      elbow crutch
•      over-the-shoulder pouch
•      knapsack
•      small cart for carrying items (a folding shopping cart, for example).

Hips and Knees
People with hip and knee arthritis need to make every effort to keep their weight down. This will limit the amount of pressure that is put on these joints.
One technique for avoiding putting undue pressure on hips and knees is to use your whole body to rise from a sitting position. Slide forward as far as you can in the seat and then lean forward over your knees and swing up. Try to push off with your forearms or palms (avoid using your fingers). Elevating yourself in the chair with a pillow will help.
Assistive Equipment. People with arthritis in the hips and knees may find the following equipment helpful. Remember that these assistive devices should not be overused. Reaching, for example, is good exercise, and if reaching is not painful for you, you probably are better off not using a long-handled reacher.
•      elevated seat with arm rests
•      raised toilet seat
•      stool
•      shower bench
•      extended shoehorn
•       long-handled reacher
•      tub grab bars
•      walking aids (cane, walker).
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RHEUMATOID ARTHRITIS: PROTECTING HANDS AND WRISTS

January 2, 2011

Finger and wrist joints tend to slowly drift out of their natural alignment as the result of chronic inflammation.
•    When stirring foods, hold the utensil with your thumb on top, as if you were holding an ice pick, and stir with shoulder motion.
•       Avoid hanging a purse strap over your wrist or carrying heavy suitcases.
•      Avoid supporting your body weight on your wrists and hands. For example, do not lean on your hands while standing against a table edge.
•    Avoid stressful wringing and twisting motions (use an electric rather than a manual can opener).
•    Do not wring your washcloth out, let the cloth drip dry. Do not grip items tightly or hold onto them for long periods. Too tight a grip increases deforming pressures.
•    Modify the size of articles that you grasp daily. You can enlarge the grips on pencils, pens, toothbrushes, and other utensils by placing the handles inside a foam hair curler or wrapping them with soft foam rubber.
•    Avoid actions that push your other fingers toward your little finger. To dial on a rotary dial telephone, hold a pencil like an ice pick. When reading, don’t hold a book in a way that puts weight on your fingers (use a book-holder). Don’t rest your chin on top of your fingers. Lift and carry objects with your palms, not with your fingers. When getting up from a chair, use your palms rather than your fingers to push off.
Remember to use the largest joint and the strongest muscle available to complete the job. For example, shut doors with your hip or upper arm rather than your fingers. Open jars by putting pressure on the top with your palm and twisting from the shoulder rather than gripping the lid with your fingers.
Splints. The splints that are available today are made of lighter weight materials and are smaller than they were in the past. They are also more comfortable and attractive than splints used to be. The ring splint is an example of a modern splint which can be used by persons with swan neck or boutonniere deformity, if the splint improves function.
Hand and wrist splints can be either commercially fabricated (purchased over the counter) or custom fit by an occupational therapist or orthotist. (An orthotist is an expert in the development and application of splints, braces, and other supports to improve function or decrease pain and inflammation.) The functional wrist splint is useful because it allows some movement at the fingers while immobilizing the wrist. Some physicians prescribe a resting hand splint to be worn at night to rest finger and wrist joints. Remember, splints should only be used if they relieve pain or improve function.
Assistive equipment. People with hand and wrist problems may find use of the following equipment helpful:
•    built-up handles
•       faucet turners / lever
•      key adaptor / lever
•       button hook
•      elastic shoelaces
•      house door opener
•       car door opener / lever
•      loop scissors
•      luggage carrier
•      mitt potholder
•      padded wrist rest for computer keyboard or typewriter.
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RHEUMATOID ARTHRITIS: JOINT PROTECTION GUIDELINES

December 12, 2010

Respect your pain. Increased pain is a warning that you are overtaxing your joints. You should heed this warning and modify the activity.
Balance rest with activity. Organizing your schedule so that you alternate energy-intensive activities with more restful ones will stretch your energy reserves and protect your joints as well. Conserving your energy by avoiding unnecessary tasks will leave you with more energy to exercise and do the necessary ones.
Maintain your muscle strength. Strong muscles provide additional support to your joints and help protect them from undue stress.
Avoid activities that cannot be stopped. Try to steer clear of prolonged activities that leave you no room or opportunity to rest. Consider that standing in a long line without being able to sit down will leave you fatigued. With some planning you can avoid peak hours and long lines at the post office, bank, and grocery store. Carrying a package for a long distance – across a parking lot, for example – is another activity that can wear you out. Again, the best way to avoid this is to plan ahead: keep a portable or fold-up cart in your car. This will allow you to transport the object without exerting much energy and to take small rest breaks during the trek if you need to.
Avoid positions that promote deformity. Sometimes ligaments and muscles become stretched with the inflammation of arthritis. This may result in unequal forces being exerted across the joints, creating a situation in which the joints drift, or change their alignment. This is known as joint deformity. The word deformity is frightening for most people. The use of the word within this setting, however, merely describes a change in the normal positioning (and, sometimes, function) of joints.
Utilize the largest joint and the strongest muscle available to complete a task. It makes good sense to call upon your most powerful joints and muscles to perform any given task. In this way you avoid putting stress upon smaller, less powerful joints and muscles. Consider the task of lifting a heavy book. If you pick the book up between your thumb and fingers, the fingers and wrist will have a great deal of stress placed on them. Instead, if you pick the book up by sliding your hands underneath the book, palms up, and then lifting it, your arm muscles and elbows will do the work, and you’ll avoid putting extra stress on your wrists and fingers.
Avoid remaining in one position or using muscles in one stationary position for long periods of time. Remaining in one position for too long promotes stiffness or a gelling effect on inflamed joints. Muscles also become fatigued when you use them from a stationary position for long periods. (Think about how your muscles begin to cramp when you write for lengthy periods without stopping or readjusting the pencil or pen.) Stiffness of joints and muscles can be avoided by changing to a different position every fifteen to twenty minutes. Frequent stretching also helps prevent joints from losing range of motion. Again, take frequent breaks, stretch, and change positions before muscle fatigue sets in.
Utilize splinting as needed. A splint is a fabricated support that is designed to stabilize inflamed joints. In RA, a splint has three basic functions. It can be designed to (1) rest an inflamed joint by partially or completely immobilizing it; (2) protect a weakened joint from injury by supporting it; and (3) improve function of a damaged joint.
Splints should only be used if they decrease pain and inflammation or improve function. There is no good evidence available that splints prevent deformity. On the other hand, it has been proven that incorrect or prolonged use of splints can lead to increased stiffness, decreased strength, and decreased motion. If you believe that you are receiving no benefit from a prescribed splint, discuss this with your physician or occupational therapist.
Utilize assistive equipment as needed. There are numerous catalogues listing accessories that are useful for people who have arthritis – so many, in fact, that the choices may be overwhelming. Our advice is to use as little in the way of assistive equipment as possible because these devices can actually interfere with your ability to function independently if you rely on them too heavily or if you use too many of them. This is not to say that there aren’t many situations in which a specific item can help you considerably and spare your joints from excessive stress.
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SYMPTOMS OF ARTHRITIS

April 29, 2009

The most common symptom of arthritis is that the joints at first become painful. The pain can have many degrees of intensity and it can come and go. Sometimes it disappears for months, even years, then it returns again. At first the pain could be a feeling of numbness and stiffness. Sometimes a creaking and cracking of the joints is felt. Often the joints become swollen and inflamed. Pain can be dull but also very severe, occurring mostly at night and in the morning.

It is important to understand that these symptoms, although they may seem to be the very first signals of approaching arthritis, are not at all the first symptoms of the onset of the disease. Arthritis is not a local disease of a particular joint but a systemic disorder, a disease which affects the whole body. It could have taken years and years of abuse to bring about the systemic disturbance in bodily functions which eventually leads to a breakdown of the health and the functions of the joints.

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SEVERE TO CRIPPLING OSTEOARTHRITIS

April 28, 2009

In Group #4, fourteen subjects presenting with severe to crippling osteoarthritis were supplied with 50 capsules to be taken in two series, two capsules each morning and evening for seven days, with a seven day interval before repeating the same dosage for 5 1/2 2 more days. Three of these subjects were unable to walk and were accustomed to being transported by wheelchairs. The other eleven could move about with crutches, walkers, or canes. All presented with pain, inflammation, and marked deformation of nearly all interphalangeal and large joints. Four presented with limited lumbar flexion and pain in the vertebral column. Ten had difficulty grasping and manipulating common objects.

After four days of treatment ten in this group reported 30% to 50% improvement in articulation and inflammation and about 40% to 60% relief of arthritic pain. In these ten subjects improvement continued rapidly over the next three days, reaching 80% to 100% by the end of seven days. One reported no perceptible change.

On the fourteenth day, at the end of the one week interval without treatment, nine subjects reported continuing minor improvement, four reported maintaining their improved status, and one continued to show no improvement. Treatment was resumed on the fifteenth day for 5 1/2 more days.

By the end of the treatment period eleven subjects reported 80% to 100% relief of pain with a return of 80% to 100% mobility. Two subjects reported 70% to 80% return of articular mobility with a 70% to 90% reduction of arthritic pain. The one non-responsive subject proved to have previous liver damage as a result of sports-related steroid abuse. Further studies are necessary to determine the role of liver function in this protocol.

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• SYMPTOMS OF ARTHRITIS